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Spielmans GI, Ellefson EM. Small Effects, Questionable Outcomes: Bremelanotide for Hypoactive Sexual Desire Disorder. JOURNAL OF SEX RESEARCH 2024; 61:540-561. [PMID: 36809187 DOI: 10.1080/00224499.2023.2175192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Efficacy outcomes are only informative to the extent that they are validated. We examined the measurement properties of efficacy measures from the phase III ("RECONNECT") bremelanotide trials for hypoactive sexual desire disorder (HSDD) in women. Continuous efficacy outcomes, including a) the Female Sexual Function Index (FSFI) and its Desire domain (FSFI-D) and b) the Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) and its item assessing distress due to low desire (FSDS-DAO #13) have questionable, at best, validity evidence for women with HSDD. We found no validity evidence for previously published categorical treatment response outcomes from the RECONNECT trials. All efficacy results should be reported, but results on 8 of the 11 clinicaltrials.gov-specified efficacy outcomes were heretofore unpublished (including FSDS-DAO total score, FSFI total score, FSFI arousal domain, and items from the Female Sexual Encounter Profile-Revised). We analyzed these outcomes, upon which effect sizes ranged from nil to small. Several other continuous and categorical outcomes generated modest apparent benefits, though nearly all of these outcomes were likely derived post-hoc. Across RECONNECT trial data from two prior publications and the current study, bremelanotide's benefits are statistically modest and limited to outcomes for which scant evidence of validity among women with HSDD exists.
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Affiliation(s)
- Glen I Spielmans
- Department of Psychology, Metropolitan State University, Saint Paul, Minnesota, USA
| | - Elaine M Ellefson
- Department of Psychology, Metropolitan State University, Saint Paul, Minnesota, USA
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Kiesner J, Bittoni C, Eisenlohr-Moul T, Komisaruk B, Pastore M. Menstrual cycle-driven vs noncyclical daily changes in sexual desire. J Sex Med 2023; 20:756-765. [PMID: 37037659 DOI: 10.1093/jsxmed/qdad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Past research on the association between sexual desire and the menstrual cycle has provided inconclusive results and has not considered the potential influence of psychological and physical changes that are frequently associated with the menstrual cycle. AIM To test the strength of association between the menstrual cycle (and associated symptoms) and changes in sexual desire. METHODS Prospective daily reports across 2 full menstrual cycles (2 months) from a sample of female university students (n = 213), were analysed. Analyses tested for average effects of the menstrual cycle on sexual desire, individual differences in these effects, and cyclical and noncyclical associations between sexual desire and the 9 menstrual cycle-related changes. Note that data presented in the current article come from a larger study from which other reports have been published. OUTCOMES Target variables were (1) daily change in sexual desire and (2) daily reports of 5 psychological changes and 4 physical changes that are commonly associated with the menstrual cycle. RESULTS Results showed that when considering average effects across participants, the menstrual cycle was associated with a small midcycle increase in sexual desire. However, multilevel analyses showed large individual differences in how the menstrual cycle influences sexual desire. Specifically, some participants showed a midcycle increase, others a perimenstrual increase, and others no change across the menstrual cycle. Moreover, results demonstrated that psychological changes were more important for predicting sexual desire as compared with physical changes. CLINICAL IMPLICATIONS These results suggest that daily measurement of sexual desire across multiple menstrual cycles may be an important tool in the assessment of sexual desire among some females. STRENGTHS AND LIMITATIONS Strengths of this study are the daily assessment of sexual desire and all symptoms for 2 menstrual cycles and multilevel analyses that allow the study of individual differences. Limitations include limited measurement of sexual desire based on only 2 questions and the lack of measures of relationship status and sexual orientation. CONCLUSION Emphasis is placed on the need to apply more rigorous research methods and to abandon simplistic average-effects models that are based on outdated theories and stereotypes.
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Affiliation(s)
- Jeff Kiesner
- Department of Psychology, Università Degli Studi di Padova, Padova 35131, Italy
| | - Celeste Bittoni
- Department of Psychology, Università Degli Studi di Padova, Padova 35131, Italy
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Barry Komisaruk
- Psychology Department, Rutgers University, Newark, NJ 07102, United States
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Daescu AMC, Dehelean L, Navolan DB, Gaitoane AI, Daescu A, Stoian D. Effects of Hormonal Profile, Weight, and Body Image on Sexual Function in Women with Polycystic Ovary Syndrome. Healthcare (Basel) 2023; 11:healthcare11101488. [PMID: 37239774 DOI: 10.3390/healthcare11101488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a hyperandrogenic endocrinological disorder associated with chronic oligo-anovulation and polycystic ovarian morphology. Compared to women without PCOS, women with PCOS have a risk of sexual dysfunction that is more than 30% higher. Although alterations in sex hormones and psychosocial wellbeing have been proposed, the precise mechanisms of FSD in PCOS remain unclear. The aim of our study was to analyze how the hormonal, clinical and psychometric parameters of PCOS patients are involved in the development of sexual dysfunction. The study group consisted of 54 women, aged between 21 and 32 years, diagnosed with PCOS. We collected the following parameters: age, body mass index (BMI), the Ferriman-Gallwey score (FG), maximum duration of oligomenorrhea, abdominal circumference (AC), free testosterone value (FT), luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio value, serum cortisol value and ovarian ultrasound appearance. At the time of the examination, patients were asked to fill in the Female Sexual Function Index (FSFI) and the Body Exposure during Sexual Activities Questionnaire (BESAQ). Statistically significant differences were observed between normal weight and overweight women regarding BESAQ (p-value = 0.02) and FSFI total (p-value <0.001). Elevated BMI, AC or BESAQ scores correlated with a lower FSFI score. The most involved domains of the scale were orgasm, arousal, and desire. Elevated BESAQ scores increase the risk of female sexual dysfunction (FSD) by 4.24 times. FT, BESAQ score, BMI, and LH/FSH ratio were found to independently predict FSD. The cutoff point for the BESAQ score in detecting FSD was found to be 1.97. Weight, body image and anxiety related to sexual activities seem to be significant components in the development of sexual dysfunction in PCOS patients, beyond the effect due to hyperandrogenism. FT value has a U-shape effect in sexual dysfunction, because both in the case of deficit and in the case of excess, sexual function is impaired. BESAQ is a strong predictor for sexual dysfunction in women with PCOS, along with FT value, LH/FSH ratio and BMI.
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Affiliation(s)
- Ana-Maria Cristina Daescu
- Doctoral School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Neurosciences Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Liana Dehelean
- Neurosciences Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dan-Bogdan Navolan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | | | - Andrei Daescu
- Department of Mathematics, Politehnica University of Timisoara, 300006 Timisoara, Romania
| | - Dana Stoian
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Harris EA, Gormezano AM, van Anders SM. Gender Inequities in Household Labor Predict Lower Sexual Desire in Women Partnered with Men. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3847-3870. [PMID: 36112330 PMCID: PMC9483460 DOI: 10.1007/s10508-022-02397-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 05/10/2023]
Abstract
Low sexual desire in women is usually studied as a problem, one that is located within women. However, other possibilities exist, including known gender inequities related to heteronormative gender roles. In this study, we provide the first test of the theory that heteronormativity is related to low sexual desire in women partnered with men, focusing specifically on inequities in the division of household labor. In two studies with women who were partnered with men and had children (Study 1, N = 677; Study 2, N = 396), performing a large proportion of household labor was associated with significantly lower sexual desire for a partner. Together, the results suggest that this association was mediated by both perceiving the partner as a dependent and perceiving the division of labor as unfair. These results support the heteronormativity theory of low sexual desire in women partnered with men, and show that gender inequities are important, though understudied, contributors to low desire in women partnered with men.
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Affiliation(s)
- Emily A Harris
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Aki M Gormezano
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Sari M van Anders
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, K7L 3N6, Canada.
- Department of Gender Studies, Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
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Negri M, de Souza E, Torloni MR, Ribeiro MC, Araujo E, Guazzelli CAF. Sexual function in Brazilian female adolescents and young adults: a cross-sectional study. Rev Assoc Med Bras (1992) 2022; 68:1210-1215. [PMID: 36228252 PMCID: PMC9575009 DOI: 10.1590/1806-9282.20220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate and compare the sexual function of Brazilian adolescents and young women who were using popular contraceptive methods. METHODS This cross-sectional study took place in 2012-2014 in a free family planning clinic of a tertiary teaching hospital in Brazil. Participants were female adolescents (10-19 years) and young adults (20-24 years) who were using barrier (condom) or hormonal contraceptive methods. The Female Sexual Function Index questionnaire was used to assess the sexual function in the last 4 weeks. RESULTS A total of 199 women (128 adolescents and 71 young adults) were included. There were no significant differences in the mean total Female Sexual Function Index scores of adolescents and young adults (26.6±5.7 versus 27.6±6.2, respectively, p=0.264). Compared to young adults, adolescents had significantly lower mean scores for orgasm (3.9±1.5 versus 4.4±1.4, p=0.020) and dyspareunia (4.4±1.6 versus 5.2±1.5, p=0.001; lower scores indicate more dyspareunia). There were no significant differences in the proportion of adolescents versus adults classified as being at risk for sexual dysfunction (38.3 versus 42.3%, p=0.651) or at risk of low desire (18.0 versus 21.1%, p=0.579). CONCLUSION Nearly 40% of Brazilian female adolescents and young adults are at risk for sexual dysfunctional symptoms and 19% have low desire, without significant differences between the two age groups.
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Affiliation(s)
- Mariana Negri
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics – São Paulo (SP), Brazil
| | - Eduardo de Souza
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics – São Paulo (SP), Brazil
| | - Maria Regina Torloni
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Internal Medicine – São Paulo (SP), Brazil
| | - Meireluci Costa Ribeiro
- Centro Universitário Salesiano de São Paulo, Postgraduate Program in Sex Therapy – São Paulo (SP), Brazil
| | - Edward Araujo
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics – São Paulo (SP), Brazil
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Maseroli E, Vignozzi L. Are Endogenous Androgens Linked to Female Sexual Function? A Systemic Review and Meta-Analysis. J Sex Med 2022; 19:553-568. [PMID: 35227621 DOI: 10.1016/j.jsxm.2022.01.515] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The benefits of treatment with testosterone (T) in women with loss of desire suggest that low androgens may distinguish women with sexual dysfunction (SD) from others; however, evidence on this point is lacking. AIM To answer the question: is there an association between endogenous levels of androgens and sexual function in women? METHODS An extensive search was performed in MEDLINE, Embase and PsycInfo. Four separate meta-analyses were conducted for total T, free T, Free Androgen Index (FAI), and Dehydroepiandrosterone sulphate (DHEAS). Cohort, cross-sectional, and prospective studies were included. OUTCOMES The main outcome was the association between endogenous androgens and sexual desire. Global sexual function was considered as a secondary outcome. The effect measure was expressed as standardized mean difference (SMD). RESULTS The meta-analysis on total T included 34 studies involving 3,268 women, mean age 36.5 years. In 11 studies, a significant association was found between sexual desire, measured by validated psychometric instruments, and total T (SMD = 0.59 [0.29;0.88], P < 0.0001), with a moderate effect. The association with global sexual function (n = 12 studies) was also significant (SMD = 0.44 [0.21;0.67], P <0.0001). Overall, total T was associated with a better sexual function (SMD = 0.55 [0.28;0.82)], P < 0.0001), with similar results obtained when poor quality studies were removed. Age showed a negative relationship with the overall outcome. No differences were found when stratifying the studies according to menopausal status, type of menopause, age at menopause, use of hormonal replacement therapy, relationship status, method for T measurement, phase of the menstrual cycle or use of hormonal contraception. The meta-analysis of T derivatives (free T and FAI) also showed a significant, moderate association with sexual desire. In contrast, DHEAS seems not to exert any significant influence on desire, whilst showing a positive association with global sexual function. CLINICAL IMPLICATIONS Endogenous androgens show a moderate association with a better sexual function in women; however, the role of psychological, relational and other hormonal factors should not be overlooked. STRENGTHS & LIMITATIONS This represents the first attempt at meta-analyzing data available on the topic. A significant publication bias was found for total T. CONCLUSION There appears to be a moderate association between total T and sexual desire/global sexual function, which is confirmed, although weak, in studies employing liquid chromatography-mass spectrometry (LC-MS). Similar results on desire were obtained for free T and FAI. DHEAS only showed a positive association with global sexual function. More research is needed. Maseroli E and Vignozzi L. Are Endogenous Androgens Linked to Female Sexual Function? A Systemic Review and Meta-Analysis. J Sex Med 2022;19:553-568.
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Affiliation(s)
- Elisa Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Experimental Clinical and Biomedical Sciences "Mario Serio," University of Florence, Italy; I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Rome, Italy.
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7
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Busby DM, Leonhardt ND, Hanna-Walker V, Leavitt CE. Putting the Dyad into the Sexual Response Discussion: A Latent Class Analysis Using Ratings of Self and Partner. JOURNAL OF SEX RESEARCH 2022; 59:185-202. [PMID: 33705212 DOI: 10.1080/00224499.2021.1891189] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this study we explored the sexual response process in couple relationships. With a U.S. sample of 383 mixed-sex couples we found seven different classes of couple sexual response using Dyadic Latent Class Growth Analysis for ratings of self and partner about their most recent sexual experience. These classes ranged from synchronous High Arousal (31.6%) and Medium Arousal (27.7%) groups, to a few classes where one partner had a quick arousal process and the other partner had very low levels of arousal. Couples in these classes were differentiated on their levels of accuracy in understanding what their partner was experiencing, as one class had couples where men experienced higher arousal than women in the first part of the experience, but the male partner was aware of the discrepancy (Equifinality, 6.8%, i.e. couples start at different levels of arousal but end up at the same place), and another where men experienced higher arousal than women throughout the experience, but men inaccurately thought their partner also experienced higher arousal (Inaccurate Split, 7.3%). The seven classes had significantly different values on variables measuring the quality of the specific sexual experience. These classes also significantly differed on a variety of measures assessing the overall sexual relationship and the relationship as a whole. These findings counter the argument that the sexual response cycle is uniform for most couples.
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Affiliation(s)
- Dean M Busby
- School of Family Life, Brigham Young University, Provo, UT, USA
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de Oliveira L, Carvalho J, Nobre P. Perceptions of sexual boredom in a community sample. JOURNAL OF SEX & MARITAL THERAPY 2020; 47:224-237. [PMID: 33289446 DOI: 10.1080/0092623x.2020.1854405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study explored the definitions of sexual boredom in a large community sample of Portuguese individuals. A thematic analysis of written responses to the question "What is sexual boredom for you?" was conducted with 653 participants aged 18 to 75 (M = 33.14; SD = 9.01) of multiple genders, sexual orientations, and relationship types. Three main themes were identified: definitions of sexual boredom, predisposing and maintenance factors of sexual boredom, and managing of sexual boredom. Sexual monotony, sexual desire, and hedonic value stand out as defining features of sexual boredom. Findings suggest the need of a multidimensional measure of sexual boredom.
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Affiliation(s)
- Leonor de Oliveira
- Center for Psychology at University of Porto, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Joana Carvalho
- Center for Psychology at University of Porto, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Pedro Nobre
- Center for Psychology at University of Porto, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
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Roslan NS, Jaafar NRN, Sidi H, Baharudin N, Kumar J, Das S, Hussain NHN. The Bio-Psycho-Social Dimension in Women's Sexual Desire: 'Argumentum ad novitatem'. Curr Drug Targets 2020. [PMID: 28641524 DOI: 10.2174/1389450118666170622090337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sexual desire includes complex motivation and drive. In the context of biological and cognitive- emotive state art of science, it is often a neglected field in medicine. In regard to the treatment, study on women's sexual function received less attention compared to the men's sexuality. In the past, this endeavor was relatively not well disseminated in the scientific community. Recently, there was a revolutionized surge of drug targets available to treat women with low sexual desire. It is timely to review the relevant biological approach, especially in the context of pharmacotherapy to understand this interesting clinical entity which was modulated by numerous interactive psychosocial inter-play and factors. The complex inter-play between numerous dimensional factors lends insights to understand the neural mechanism, i.e. the rewards centre pathway and its interaction with external psychosocialstimulus, e.g. relationship or other meaningful life events. The function of hormones, e.g. oxytocin or testosterone regulation was described. The role of neurotransmitters as reflected by the introduction of a molecule of flibenserin, a full agonist of the 5-HT1A and partial agonist of the D4 to treat premenopausal women with low sexual desire was deliberated. Based on this fundamental scientific core knowledge, we suggest an outline on know-how of introduction for sex therapy (i.e. "inner-self" and "outer-self") where the role of partner is narrated. Then, we also highlighted on the use of pharmacological agent as an adjunct scope of therapy, i.e. phosphodiasterase-5 (PDE-5) inhibitors and hormonal treatment in helping the patient with low sexual desire.
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Affiliation(s)
- Nur Syazwani Roslan
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Nik Ruzyanei Nik Jaafar
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Hatta Sidi
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Najwa Baharudin
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Jaya Kumar
- Department of Physiology, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Srijit Das
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Nik Hazlina Nik Hussain
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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McNabney SM, Wiese GN, Rowland DL. From Table to Bedroom: Nutritional Status, Dietary Interventions, and Women’s Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Cherkasskaya E, Rosario M. The Relational and Bodily Experiences Theory of Sexual Desire in Women. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1659-1681. [PMID: 29926262 DOI: 10.1007/s10508-018-1212-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
We review the theory and research on women's sexual desire and present a theory that incorporates internalized representations of relational and bodily experiences into our understanding of the full range of desire in women. To this end, we move away from the current tendency to focus on low sexual desire in women and instead consider desire on a spectrum or continuum from absent or diminished to high desire across multiple sexual orientations, including heterosexual, bisexual, and lesbian. We review definitions of sexual desire, as well as the epidemiology and etiology of hypoactive sexual desire, the most prevalent sexual complaint in women, including the biological, psychological, and relationship correlates of inhibited sexual desire. Subsequently, we examine the research on highly sexual women, who tend to experience high levels of sexual desire, sexual agency, and sexual esteem, and distinguish between high sexual desire and hypersexuality. We introduce two important constructs that are integrated into the Relational and Bodily Experiences Theory (RBET) of sexual desire in women: attachment and sexual body self-representations, suggesting that women's internalized representations of self and other that stem from childhood and their capacity to embody their sexual bodies are integral to our understanding of the phenomenology of sexual desire in women. RBET calls for further research into the links between attachment, sexual body self-representations, and desire, and suggests that clinical interventions for sexual desire difficulties in women should emphasize internalized working models of relationships (i.e., attachment) and integrate bodily based approaches.
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Affiliation(s)
- Eugenia Cherkasskaya
- Counseling and Psychological Services/Columbia Health, Columbia University, Alfred Lerner Hall, 8th Floor, 2920 Broadway, Mail Code 2606, New York, NY, 10027, USA.
| | - Margaret Rosario
- Department of Psychology, City University of New York-City College and The Graduate Center, New York, NY, USA
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Basson R. Are Healthy Parental Attachments and Resilience to Societal Objectification Basic to Women's Sexual Health? ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1683-1687. [PMID: 30465313 DOI: 10.1007/s10508-018-1314-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 09/20/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Rosemary Basson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.
- Sexual Medicine, University of British Columbia, Vancouver, BC, Canada.
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
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13
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Rosen NO, Bergeron S. Genito-Pelvic Pain Through a Dyadic Lens: Moving Toward an Interpersonal Emotion Regulation Model of Women's Sexual Dysfunction. JOURNAL OF SEX RESEARCH 2019; 56:440-461. [PMID: 30252510 DOI: 10.1080/00224499.2018.1513987] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Researchers and clinicians alike widely acknowledge the inherently interpersonal nature of women's sexual dysfunctions given that both partners impact and are impacted by these difficulties. Yet theoretical models for understanding the role of interpersonal factors in women's sexual dysfunctions are severely lacking and have the potential to guide future research and inform more effective interventions. The most widely studied sexual dysfunction in women that has espoused a dyadic approach by including both members of affected couples is genito-pelvic pain/penetration disorder (GPPPD). In this article we use the example of GPPPD to introduce a novel interpersonal emotion regulation model of women's sexual dysfunction. We first review current knowledge regarding distal and proximal interpersonal factors in GPPPD. Then, we describe our theoretical model and consider relevant pain and sex-related research on emotion regulation processes-emotional awareness, expression, and experience-in the context of GPPPD, including sexual function, satisfaction, and distress. Next, we review how existing theories from the fields of chronic pain and sex and relationships research have informed our model and how our model further builds on them. Finally, we discuss the implications of our model and its applications, including to other sexual dysfunctions in women.
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Affiliation(s)
- Natalie O Rosen
- a Department of Psychology and Neuroscience , Dalhousie University
- b Department of Obstetrics and Gynecology , IWK Health Centre
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Dos Santos KM, Da Roza T, da Silva LL, Wolpe RE, da Silva Honório GJ, Tonon da Luz SC. Female sexual function and urinary incontinence in nulliparous athletes: An exploratory study. Phys Ther Sport 2018; 33:21-26. [PMID: 29982034 DOI: 10.1016/j.ptsp.2018.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 06/02/2018] [Accepted: 06/13/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To estimate the prevalence of Female Sexual Dysfunction (FSD) and Urinary Incontinence (UI) symptom in nulliparous athletes and analyze the risk factors for these dysfunctions. DESIGN A cross-sectional study. SETTING The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) and the Female Sexual Function Index (FSFI) were applied to assess the UI and the FSD. PARTICIPANTS 50 athletes with ≥18 years old. RESULTS We found a prevalence of 48% of UI and 44% of FSD among nulliparous athletes. The rate of athletes having concomitant FSD and UI was 24%. We found a significant difference between high and low impact sports in the ICIQ-UI-SF score (p = 0.028). Hours of training (p = 0.007; R2 = 0.21) was found to be a risk factor for UI. Incontinent athletes demonstrated a Relative Risk of 2.7 to develop sexual desire problem when compared to the continents (p = 0.04; 95% CIs: 1.50-4.89). CONCLUSIONS This study found a high prevalence of both UI and FSD among nulliparous athletes. Furthermore, nulliparous athletes practicing high-impact modalities are the most susceptible to UI. The hours of training per day was considered a risk factor to develop UI, and incontinent athletes have more chances of showing difficulties in sexual desire.
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Affiliation(s)
- Keyla Mara Dos Santos
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), State University of Santa Catarina (UDESC), Florianópolis, SC, Brazil.
| | - Thuane Da Roza
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), State University of Santa Catarina (UDESC), Florianópolis, SC, Brazil.
| | - Lislayne Luiza da Silva
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), State University of Santa Catarina (UDESC), Florianópolis, SC, Brazil.
| | - Raquel Eleine Wolpe
- Laboratory of Women's Health, Center for Health and Sports Sciences (CEFID), State University of Santa Catarina (UDESC), Florianópolis, SC, Brazil.
| | - Gesilani Júlia da Silva Honório
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), State University of Santa Catarina (UDESC), Florianópolis, SC, Brazil.
| | - Soraia Cristina Tonon da Luz
- Laboratory of Biomechanics, Center for Health and Sports Sciences (CEFID), State University of Santa Catarina (UDESC), Florianópolis, SC, Brazil.
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Sartorius G. Androgene und weibliche Libido. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sørensen T, Giraldi A, Vinberg M. Sexual distress and quality of life among women with bipolar disorder. Int J Bipolar Disord 2017; 5:29. [PMID: 28589489 PMCID: PMC5461226 DOI: 10.1186/s40345-017-0098-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/30/2017] [Indexed: 12/23/2022] Open
Abstract
Background Information on the association between bipolar disorder (BD), sexual satisfaction, sexual function, sexual distress and quality of life (QoL) is sparse. This study aims, in women with BD, to (i) investigate sexual dysfunction, sexual distress, general sexual satisfaction and QoL; (ii) explore whether sexual distress was related to affective symptoms and (iii) investigate whether QoL was associated with sexual distress. The study is a questionnaire survey in an outpatient cohort of women with BD using: Changes in Sexual Functioning Questionnaire, Female Sexual Distress Scale, Altman Self-Rating Mania Scale (ASRM), Major Depression Inventory (MDI) and The World Health Organisation Quality of Life-Brief. Results In total, 61 women (age range 19–63, mean 33.7 years) were recruited. Overall, 54% reported sexual distress (n = 33) and 39% were not satisfied with their sexual life (n = 24). Women with BD were significantly more sexually distressed in comparison with Danish women from the background population but they did not have a higher prevalence of impaired sexual function. Better sexual function was positively associated with ASRM scores while MDI scores were associated with more distress. Finally, the group of non-sexually distressed women with BD reported higher QoL scores compared with the sexually distressed group. Conclusions Women with BD exhibited a high prevalence of sexual distress and their sexual function seemed associated with their actual mood symptoms and perception of QoL.
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Affiliation(s)
- Thea Sørensen
- Copenhagen Affective Disorder Clinic, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Dep. 6233, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Sexological Clinic, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - A Giraldi
- Sexological Clinic, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Vinberg
- Copenhagen Affective Disorder Clinic, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Dep. 6233, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Garneau-Fournier J, McBain S, Torres T, Turchik J. Sexual Dysfunction Problems in Female College Students: Sexual Victimization, Substance Use, and Personality Factors. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:24-39. [PMID: 26683983 DOI: 10.1080/0092623x.2015.1113595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Little empirical information is available on sexual dysfunction (SD) among college women even though college years represent a critical period in the development of sexuality. The current study aimed to identify factors associated with the presence, number, and type of SD problems among 547 female college students in the United States. Racial minority status, problematic drinking behaviors, and past sexual victimization were positively related to the presence of SD problems, whereas hormonal contraceptive use and past sexual victimization were associated with a greater number of SD problems. These findings highlight the importance of assessment, treatment, and prevention of sexual health issues on college campuses.
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Affiliation(s)
- Jade Garneau-Fournier
- a Pacific Graduate School of Psychology at Palo Alto University and Center of Innovation to Implementation, VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Sacha McBain
- a Pacific Graduate School of Psychology at Palo Alto University and Center of Innovation to Implementation, VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Tammy Torres
- b Pacific Graduate School of Psychology-Stanford Consortium Psy.D. Program and Center of Innovation to Implementation, VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Jessica Turchik
- c Center of Innovation to Implementation, VA Palo Alto Health Care System, National Center for PTSD , VA Palo Alto Health Care System, Palo Alto , California , USA
- d Department of Psychiatry and Behavioral Sciences , Stanford University , Menlo Park , California , USA
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Sarin S, Amsel R, Binik YM. A Streetcar Named "Derousal"? A Psychophysiological Examination of the Desire-Arousal Distinction in Sexually Functional and Dysfunctional Women. JOURNAL OF SEX RESEARCH 2016; 53:711-729. [PMID: 26457746 DOI: 10.1080/00224499.2015.1052360] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Research indicates that desire and arousal problems are highly interrelated in women. Therefore, hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and a new diagnostic category, female sexual interest/arousal disorder (FSIAD), was created to include both arousal and desire difficulties. However, no research has tried to distinguish these problems based on psychosocial-physiological patterns to identify whether unique profiles exist. This study compared psychosocial-physiological patterns in a community sample of 84 women meeting DSM-IV (American Psychiatric Association, 2000 ) criteria for HSDD (n = 22), FSAD (n = 18), both disorders (FSAD/HSDD; n = 25), and healthy controls (n = 19). Women completed self-report measures and watched neutral and erotic films while genital arousal (GA) and subjective arousal (SA) were measured. Results indicated that GA increased equally for all groups during the erotic condition, whereas women with HSDD and FSAD/HSDD reported less SA than controls or FSAD women. Women in the clinical groups also showed lower concordance and greater impairment on psychosocial variables as compared to controls, with women with FSAD/HSDD showing lowest functioning. Results have important implications for the classification and treatment of these difficulties.
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Malary M, Khani S, Pourasghar M, Moosazadeh M, Hamzehgardeshi Z. BIOPSYCHOSOCIAL DETERMINANTS OF HYPOACTIVE SEXUAL DESIRE IN WOMEN: A NARRATIVE REVIEW. Mater Sociomed 2016; 27:383-9. [PMID: 26889096 PMCID: PMC4733555 DOI: 10.5455/msm.2015.27.383-389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: As a mental response to sexual stimuli, sexual desire determines human sexual behavior and represents the cognitive capacity of sexual stimulation, so that avoiding sexual activity has a very negative effect on the discharge of intimacy and joy in couple’s relationship and threatens the stability relationship, which can finally end in sexual dissatisfaction and divorce; it may even affect the reproduction. This study, reviews the literature on biopsychosocial determinants of hypoactive sexual desire disorder in women in childbearing ages. Method: The search was done from January to March 2015 by the use of the data bases ProQuest, Pubmed, CINAHL, Ovid and Medline and the words sexual desire, related factors and biopsychosocial determinants were used as free text words. The words reduce sexual desire, hypoactive sexual desire disorder, dyadic relationship, biopsychosocial factors and women were used as keywords in the search. Also, the articles focusing on any aspects of sexual desire such as biological, social and psychological factors and relationship factors alone or integrated, were included in the study. The articles which specifically targeted the hypoactive sexual desire disorder in pregnant and lactating women and also the articles targeting biopsychosocial factors related to other types of sexual function disorder such as arousal disorder, orgasm disorder and dyspareunia, were all excluded from this study. Findings: After reviewing the literature, the findings were categorized in three main class of effect of biologic factors on sexual desire and sexual hypoactivity, the effect of psychological factors on sexual desire and the effect of cultural factors and couple’s relationship on sexual desire, each of these domains cover a wide range (such as hormonal changes, chronic diseases, psychological difficulties (perceived stress, anxiety, depression). Incompatibility of couples, the spouse’s sexual function disorder) which may overlap. Because of the complexity of etiology and the difficulty of treating hypoactive sexual desire disorder, it is necessary to use biopsychosocial approaches to diagnose and treat the disorder. Conclusion: According to the findings of this reviewing study, the factors able to affect sexual desire and activity are not distinct and often overlap, therefore, the complicated etiology of hypoactive sexual desire disorder often needs multidimensional intervention to use biopsychosocial approach; Multi factor assessment with a combination of psychological, physical, social and hormonal intervention can be effective in making strategies to treat the symptoms of HSDD.
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Affiliation(s)
- Mina Malary
- Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran; Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soghra Khani
- Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Pourasghar
- Department of Psychiatry and Research Center for Psychiatry and Behavioral Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Hamzehgardeshi
- Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran; Traditional and Complementary Medicine Research Centre, Mazandaran University of Medical Sciences, Sari, Iran
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Wåhlin-Jacobsen S, Pedersen AT, Kristensen E, Læssøe NC, Lundqvist M, Cohen AS, Hougaard DM, Giraldi A. Is There a Correlation Between Androgens and Sexual Desire in Women? J Sex Med 2015; 12:358-73. [DOI: 10.1111/jsm.12774] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Crisp C, Vaccaro C, Fellner A, Kleeman S, Pauls R. The influence of personality and coping on female sexual function: a population survey. J Sex Med 2014; 12:109-15. [PMID: 25367442 DOI: 10.1111/jsm.12735] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is a common disorder with limited data investigating relationships with psychological influences, such as personality traits and coping mechanisms. AIM To investigate the relationship and impact of personality traits and coping strategies on female sexual function. METHODS A web-based survey was distributed to a sample of women representative of the area's demographic distribution. MAIN OUTCOME MEASURES Participants completed the Female Sexual Function Index (FSFI), the Ten Item Personality Index (TIPI), and the Brief COPE. RESULTS Five hundred twenty-six females responded. The mean total FSFI score was 24.56 (SD 6.77) with lowest scores in the desire domain. Personality scores were similar to published normative values. Subjects displaying stronger tendencies for introversion (r = 0.246, P < 0.001), not being open to new experiences (r = 0.159, P = 0.008), and emotional instability (r = 0.244, P < 0.001) were found to have significantly worse sexual function. Conscientiousness was significantly associated with better desire, orgasm, satisfaction, and total FSFI score (P = 0.029, P = 0.002, P = 0.005, P = 0.003). Moreover, the utilization of negative coping strategies such as self-blame, self-distraction, and behavioral disengagement, significantly correlated with poor sexual function (r = -0.298, P < 0.001, r = -0.360, P < 0.001, r = -0.398, P < 0.001, respectively). CONCLUSION Personality and coping are linked to sexual function with introversion, not being open to new experiences, emotional instability, and the utilization of negative coping strategies being significantly associated with poor sexual function. Women presenting with sexual function complaints may need further evaluation of their personality and coping strategies in order to mitigate any negative impact of these tendencies.
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Affiliation(s)
- Catrina Crisp
- Division of Urogynecology and Reconstructive Pelvic Surgery, TriHealth Good Samaritan Hospital, Cincinnati, OH, USA
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Bertin J, Dury AY, Ouellet J, Pelletier G, Labrie F. Localization of the Androgen‐Synthesizing Enzymes, Androgen Receptor, and Sex Steroids in the Vagina: Possible Implications for the Treatment of Postmenopausal Sexual Dysfunction. J Sex Med 2014; 11:1949-61. [DOI: 10.1111/jsm.12589] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Alvisi S, Baldassarre M, Lambertini M, Martelli V, Berra M, Moscatiello S, Marchesini G, Venturoli S, Meriggiola MC. Sexuality and psychopathological aspects in premenopausal women with metabolic syndrome. J Sex Med 2014; 11:2020-8. [PMID: 24848980 DOI: 10.1111/jsm.12585] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that have been suggested to impact female sexual function. AIMS This study aims to assess the prevalence of female sexual dysfunction (FSD) in premenopausal women with MetS compared with healthy controls (HC). Psychopathological aspects and the relationship to FSD were also evaluated in both groups. METHODS Two hundred four premenopausal women, of whom 98 had diagnosis of MetS, were asked to complete the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and the Middlesex Hospital Questionnaire (MHQ). Routine laboratory tests and anthropometric measurements were routinely performed. MAIN OUTCOME MEASURES FSFI and FSDS questionnaires, prevalence of FSD, and MHQ scores. RESULTS In the MetS group compared with the HC group, we found: a lower global FSFI score (P=0.005), higher prevalence of pathological scores compared with HC group, and lower scores in the desire, arousal, lubrication, and orgasm domains. An inverse correlation between the FSFI score and the number of risk factors for MetS was detected. MetS women reported significantly higher total scores in the somatization and depression domains when compared with the HC group. The logistic regression showed that high triglycerides (odds ratio [OR] 3.097; 95% confidence interval [CI] 1.272-7.542; P=0.026) and somatization (OR 7.068; CI 95% 2.291-21.812; P=0.001) are independently associated with FSD in premenopausal women. CONCLUSIONS Our results indicate a higher prevalence of sexual dysfunction in MetS women. A number of risk factors for MetS are positively associated with FSD and higher triglycerides seem to be the strongest predictors of sexual dysfunction. Psychopathological dimensions such as somatization are strongly associated with sexual dysfunction.
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Affiliation(s)
- Stefania Alvisi
- Gynecology and Physiopathology of Human Reproduction, University of Bologna and S.Orsola-Malpighi Hospital, Bologna, Italy
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Berry MD, Berry PD. Contemporary Treatment of Sexual Dysfunction: Reexamining the Biopsychosocial Model. J Sex Med 2013; 10:2627-43. [DOI: 10.1111/jsm.12273] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Sarin S, Amsel RM, Binik YM. Disentangling desire and arousal: a classificatory conundrum. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1079-1100. [PMID: 23546888 DOI: 10.1007/s10508-013-0100-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 09/03/2012] [Accepted: 11/08/2012] [Indexed: 06/02/2023]
Abstract
A controversial proposal to collapse sexual disorders of desire and arousal is forthcoming in the diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). Yet, no study has attempted to empirically distinguish these disorders by using explicit criteria to recruit and compare distinct groups of low desire and arousal sufferers. The goal of the current study was to test the feasibility of finding medically healthy men and women meeting clearly operationalized DSM-IV-TR criteria for disorders of desire and/or arousal and compare them to matched controls. To assess operational criteria, participants completed a comprehensive telephone screening interview assessing DSM-IV-TR and DSM-5 criteria, as well as standardized self-report measures of sexual functioning. The use of operationalized DSM-IV-TR criteria to recruit participants led to the exclusion of over 75% of those reporting sexual difficulties, with the primary reason for exclusion being failure to meet at least one central diagnostic criterion. The application of the DSM-5 criteria was even more restrictive and led to the exclusion of all but four men and one woman using the original four-symptom criteria, and four men and five women using the revised three-symptom criteria. Cluster analyses supported the distinction between desire and genital arousal difficulties, and suggest that different groups with distinct clusters of symptoms may exist, two of which are consistent with the DSM-5 criteria. Overall, results highlight the need for revisions to the diagnostic criteria, which, as they stand, do not capture the full range of many people's sexual difficulties.
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Affiliation(s)
- Sabina Sarin
- Department of Psychology, McGill University, 1205 Dr. Penfield Ave., Montreal, QC, H3A 1B1, Canada.
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van Anders SM. Beyond masculinity: testosterone, gender/sex, and human social behavior in a comparative context. Front Neuroendocrinol 2013; 34:198-210. [PMID: 23867694 DOI: 10.1016/j.yfrne.2013.07.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/04/2013] [Accepted: 07/06/2013] [Indexed: 12/16/2022]
Abstract
Largely based on pre-theory that ties high testosterone (T) to masculinity, and low T to femininity, high T is mainly studied in relation to aggression, mating, sexuality, and challenge, and low T with parenting. Evidence, however, fails to support this, and the social variability in T is better accounted for by a competition-nurturance trade-off as per the Steroid/Peptide Theory of Social Bonds (van Anders et al., 2011). Four key domains are discussed: adult-infant interactions, sexual desire, sexual behavior, and partnering. Empirical engagements with gender/sex are shown to lead to important insights over assumptions about masculinity-femininity. Humans are discussed within a comparative framework that attends to cross-species principles informed by human insights alongside human-specific particularities like social constructions, which are critical to evolutionary understandings of the social role of T. This paper thus integrates seemingly orthogonal perspectives to allow for transformative approaches to an empirically-supported social phenomenology of T.
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Affiliation(s)
- Sari M van Anders
- Departments of Psychology & Women's Studies, Programs in Neuroscience, Reproductive Sciences, and Science, Technology, & Society, University of Michigan, Ann Arbor, MI 48105, USA.
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Abstract
OBJECTIVE To evaluate the urological management of the relationship of the couple with both male and female sexual dysfunction. MATERIALS AND METHODS Review of the guidelines published on this subject in the Medline database together with our own clinical experience in this field. RESULTS To optimize therapy the urologist should consider the couple when a patient presents with a sexual symptom otherwise the risk of inappropriate, unsuccessful treatment is high. If a dysfunctional relationship is clearly present, with major conflict between the partners or a marked lack of communication, these negative couples must be seen for sex therapy within a multidisciplinary approach. Even with a positive couple, without major conflict, it is advisory to include the partner in the diagnosis and the treatment, for her attitude as a factor which can influence the sexual motivation of the couple, the means and results of the management. In addition, poor knowledge of a sexual problem concerning the woman, whether this predates the partner's dysfunction or not, can impede the efficacy of pharmaceutical treatment. CONCLUSION Thus, the couple should be seen as a clinical entity with its own fulfillment, which plays an important role in treatment effectiveness, in compliance. Adapting the management to the real expectations of the patient and the couple is essential. With the possible help of the pharmacological treatments of sexual symptoms, a work on all aspects of the couple's dysfunction should bring a new harmony in sexual and affectionate aspects of the relationship.
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Cour F, Bonierbale M. Troubles du désir sexuel féminin. Prog Urol 2013; 23:562-74. [DOI: 10.1016/j.purol.2012.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 01/23/2023]
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Hernández Hernández JR, López-Tomassetti Fernández E, Caballero Díaz Y, Molina Cabrillana J, Morales García D, Núñez Jorge V. Remission of female sexual dysfunction in morbidly obese female patients with the Scopinaro procedure. Surg Obes Relat Dis 2013; 9:987-90. [PMID: 23561961 DOI: 10.1016/j.soard.2013.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 01/28/2013] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prevalence of obesity has increased in Spain in recent years. Obese women are at increased risk for sexual dysfunction, and important remission of this condition has been previously reported with bariatric surgery. OBJECTIVES The major aim of this study was to assess the effects of the Scopinaro biliopancreatic diversion on female sexual dysfunction (FSD) using a validated Female Sexual Function Index (FSFI). METHODS Eighty sexually active women with morbid obesity and with FSD underwent surgery. All patients completed the FSFI before surgery, as well as 6 and 12 months after surgery. The FSFI evaluates the sexual function using 6 items: desire, arousal, lubrication, orgasm, satisfaction, and pain. We used a<26.5 cut-point to assess the presence of FSD. This cut-point is used as a standard for the investigation. RESULTS Before surgery, all patients had FSD (mean 19.9±1.6). Six months after surgery, the FSD improved (mean 25.4±4.1; P<.001), and 12 months after surgery FSD resolved in most of the patients (mean 30.4±3.5; P<.001). All of the parameters evaluated by the FSFI (P<.001) improved significantly in all patients. CONCLUSION FSD improved significantly 6 months after biliopancreatic diversion among obese women with preoperative sexual dysfunction and continued improving up to 12 months later.
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Affiliation(s)
- Juan R Hernández Hernández
- General Surgery Service of the Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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van Anders SM. Testosterone and sexual desire in healthy women and men. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:1471-84. [PMID: 22552705 DOI: 10.1007/s10508-012-9946-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 02/23/2012] [Accepted: 02/25/2012] [Indexed: 05/10/2023]
Abstract
Sexual desire is typically higher in men than in women, with testosterone (T) thought to account for this difference as well as within-sex variation in desire in both women and men. However, few studies have incorporated both hormonal and social or psychological factors in studies of sexual desire. The present study addressed how three psychological domains (sexual-relational, stress-mood, body-embodiment) were related to links between T and sexual desire in healthy adults and whether dyadic and solitary desire showed associations with T. Participants (n = 196) were recruited as part of the Partnering, Physiology, and Health study, which had 105 men and 91 women who completed questionnaires and provided saliva for cortisol and T assays. T was positively linked to solitary desire in women, with masturbation frequency influencing this link. In contrast, T was negatively correlated with dyadic desire in women, but only when cortisol and perceived social stress were controlled. Replicating past findings, no significant correlations between T and desire in men were apparent, but these analyses showed that the null association remained even when psychological and confound variables were controlled. Men showed higher desire than women, but masturbation frequency rather than T influenced this difference. Results were discussed in terms of challenges to assumptions of clear links between T and desire, gendered approaches to T, and the unitarity of desire.
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Affiliation(s)
- Sari M van Anders
- Departments of Psychology & Women's Studies, Program in Neuroscience, Reproductive Sciences Program, University of Michigan, Ann Arbor, MI 48109, USA.
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Cour F, Robain G, Claudon B, Chartier-Kästler E. [Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms]. Prog Urol 2012; 23:780-92. [PMID: 23830273 DOI: 10.1016/j.purol.2012.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 10/15/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions. MATERIAL AND METHODS Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience. RESULTS A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry. CONCLUSIONS Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.
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Affiliation(s)
- F Cour
- Service d'urologie, université de Versailles-Saint-Quentin-en-Yvelines, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Clayton AH, DeRogatis LR, Rosen RC, Pyke R. Intended or Unintended Consequences? The Likely Implications of Raising the Bar for Sexual Dysfunction Diagnosis in the Proposed DSM‐V Revisions: 1. For Women with Incomplete Loss of Desire or Sexual Receptivity. J Sex Med 2012; 9:2027-39. [DOI: 10.1111/j.1743-6109.2012.02850.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Current World Literature. Curr Opin Obstet Gynecol 2012; 24:265-72. [DOI: 10.1097/gco.0b013e3283564f02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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